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UNBOILED v. BOILED MILK.
1859
resides horses and stock. The slowness of the operations
NAVAL
AND
MILITARY CONCERT.
recently reported from South Africa has given rise to A grand naval and military concert under the patronage the impression that the reinforcements, especially of a of the King and the Queen will be held at the .mounted kind, are inadequate. Be this as it may, it is Crystal Palace in aid of service charities on Saturday impossible to doubt that the vast extent of country that has afternoon, July 6th, at 3 P.M., for the benefit of to be guarded and over which the operations extend, the the following funds :-The Soldiers’ and Sailors’ Families plitting up and dispersal of the Boers into numerous small Association, the Royal Naval Fund, the Soldiers’ Daugters’ bodies, and the enormous number of prisoners, women and Home, the Royal School for Daughters of Officers of children committed to our charge and requiring to be the Army, the Royal School for Naval and Marine treated in accordance with modern ideas of humanity and Officers’ Daughters, the Soldiers’ and Sailors’ Help philanthropy, make up a formidable as well as a very costly Society, Lady Lansdowne’s Officers’ Families Fund, ,undertaking-amounting to a weekly expenditure of some the National Memorial Gordon Boys’ Home, Lady While many people at home million and a quarter. Dudley’s Fund for Invalid Officers and Nurses, and the are declaiming against the evils of camps of concentraCentral British Red Cross Committee. Tickets for reserved tion and our inhumanity, independent military critics and numbered seats are one guinea and half-a-guinea rewho have been present at the seat of war are, on the other include admission to the Palace. They may spectively and band, astonished at the humane consideration, amounting as be obtained from the honorary secretary and treasurer, Mrs. they think to weakness, with which this war has been waged. Ronalds, 7, or from any of the usual libraries Madame Alice Bron, in her " Diary of a Nurse in South and ticket Cadogan-place, Extra fast trains will be run on the day agencies. has a very different story to tell and gives a very Africa," in and a display of fireworks will be given in different picture of the Boers to that presented by their thequestion As aspecial musical event the concert, with the massed evening. and in friends encomiasts this country and abroad. There is bands of 20 regiments numbering over 600 picked musicians, no denying the fact that the army medical officers who have will be a novelty. Full particulars of the programme will be served in South Africa are, as we have said, dissatisfied and announced in a few days. Miss Margaret Macintyre, Miss disappointed with the adverse criticism to which they have Marie Brema, Mr. Ben Davies, Mr. Santley, and Signor been exposed on the part of a number of irresponsible people Ancona have their assistance. kindly promised who were simply incompetent to form anything like a - correct estimate of the
situation
or
of
the
DEATHS
excellent
IN THE
SERVICES.
Lieutenant-Colonel George Lemon Walker, I.M.S., Pro,professional and administrative work which was done during this campaign-and generally under the most difficult and fessor of Medical Jurisprudence in the Medical College, trying circumstances. Nor, it must be admitted, are Madras, recently, aged 52 years. He entered the Indian speeches like that delivered by Dr. R. Craig Dun on the Medical Service in 1876, was promoted to surgeon-major in occasion of a dinner recently given by the pro- 1888, and to surgeon-lieutenant-colonel in 1896. He took part fession in Liverpool to the civil surgeons lately re- in the operations against the Rumpa rebels in 1879.
Correspondence.
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_
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____
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1860 that I venture to raise the question of its wisdom. That raw milk may be contaminated by various bacilli-such as the bacillus tuberculosis, the bacillus typhosus, the bacillus diphtherias, the streptococcus soarlatinse, and even, through the addition of polluted- water, the bacillus enteritidis sporogenes and the bacillus coli communis-I fully admit. But are these evils so frequent and so fatal as to counterbalance the disadvantages arising from the diminution or destruction of the nutritive properties of milk which boiling undoubtedly prodnces7 And the gravity of the case is increased when it is remembered that milk should be the staple food of the infant, the child, the aged, and the sick. The occurrence of illness, epidemics, and death from the " presence of extraneous poisons in11 afresh or raw milk is certain, but could not these be met by greater care, enforced by more severe penalties for neglect, and by stopping the supply of milk when disease occurs without habitually destroying the nutritive value of milk by artificial means ? When railway accidents happen which maim and kill the. advice tendered is not that travellers should stay at home, but that more stringent precautions should be taken to prevent such disasters. And in the case of milk epidemics the remedy should not be habitually to diminish or to destroy the nutritive value of the most valuable food we possess, looking to the number whom it concerns, but to require sufficient precautions regulated by efficient inspection at the source of supply. I maintain that even the accidental poisoning of milk is much less baneful to the community generally than the destruction of its nutritive qualities, which means for artificially-reared infants rickets, infantile scurvy, and tuberculous diseases and for the aged and the sick deficient nutrition. These sufferings are incalculable and often lifelong, while those of epidemics are usually limited, owing to the care expended on their investigation by the medical officers of health. That "fresh"or raw milk cannot be so deleterious an article of food as ’is asserted is proved beyond all question by the fact that during a period of 30 years in which I have had charge of the health of a very susceptible community-a great public school-I have had only four cases of typhoid fever, three cases of diphtheria (not one of which was occasioned by milk), and none of tuberculous disease, and yet the boys drink an enormous quantity of milk-so great that I have been censured by a member of the profession for the quantity I advocate and have secured for their welfare, which is never boiled and rarely warmed. In my daily practice outside the school I am perpetually asked by those who have children to rear whether the milk ought to be boiled and my invariable answer is in the negative. For, if there is one thing that is essential to the vigorous growth of children it is a I plentiful allowance of milk. How children can be expected to develop on boiled milk and the constant restriction of , sugar is beyond comprehension. It is clear to me that the educated, as well as the uneducated, public require to be taught1. That the nutritive value of milk is very largely diminished by boiling. 2. That this is true also of sterilised milk, which should therefore only be used for a short time in order to tide over a difficulty in the early artificial feeding of infants. The nature of the change produced by the heating -of milk, and which is so deleterious, is not accurately ascertained, but I will produce an instance of its effect. Some time since I attended an infant who did not thrive and who was perpetually crying on the slightest movement. For this I was unable to account although I was answerable for its feeding. Because of its condition another opinion was sought and the child was declared to be syphilitic, so that mercury with chalk was prescribed, although, beyond doubt, no such taint existed in either parent. By-and-by, however, unmistakeable signs of infantile scurvy appeared, with the extreme pallor, the pain on movement of its lower limbs, the typical epiphyseal swellings of the lower ends of the tibias, and all the other symptoms so accurately described by Sir Thomas Barlow. It turned out that while I was responsible for the food a lady gossip was answerable for the milk-boiling, hence the result. As soon as this was rectified and anti-scorbutic food was administered the child begau to thrive and rewarded the mother for the care bestowed. 3. That while milk contains all the essential ingredients for growth, as well as nourishment-viz., albumin, fat, -
This sugar, salts, and water-it contains no starch. addition to the infant’s food which is so prevalent is most injurious to the welfare of the child. Until I can be convinced that the value of milk-boiling outweighs its defects I have but the advice to give to those who do me the honour to consult me-Don’t ! If ever the time should arrive that milk must be invariably boiled it should be done as soon as it leaves the cow’s udder and befoie it is distributed. But, at present, the issues of boiled milk, as I have pointed out, are milk are remote. The remedy for certain, those of unboiled the disadvantages of "fresh" or raw milk is not wasteful destruction of its nutritive value by boiling, but the enforcement of efficient inspection of dairy cows, dairies, milkers, and dairy keepers who supply it wholesale and the ensuring of cleanliness also on the part of the retailer. I am, Sirs, yours faithfully, CLEMENT DUKES, M.D., F.R.C.P. Lond. Rugby, June 14th, 1901.
"THE CONTAMINATION OF POST-OFFICES." To th8 Editors of THE LANCET. your article in THE LANCET of on the " Contamination of Postoffices," I should be obliged if you could allow me a little space in which to point a moral from the action of the French Government. And en passant may I remind you that I sent you a marked copy of the Telegraph Ohroniole some time back, in which I published a complete translation of Dr. Mignot’s report and the decrees thereanent which In 1895 I tendered eviM. Millerand had promulgated. dence to Lord Tweedmouth’s Committee which was designed to prove an unduly high incidence of phthisis among certain classes of employes in the English Post-office. This evidence received considerable attention from THE LANCET and other medical journals. In reply to my contentions it was stated that my figures were unreliable and referred to damaged lives. This contention I combated, and after some years of further study of the matter I am still of opinion that the statistics I gathered gave a substantially accurate view of the mortality rate from phthisis in the British postal service. They showed that of every 100 deaths among sorting clerks and telegraphists during a period of 10 years 45’4 per cent. were due to phthisis. Following upon the notice attracted to the question in 1895 the Postmaster-General commenced the publication of some meagre statistics in his annual report, and has continued to give these statistics up to the present time. They are unclassified, and the whole of the varied occupations of the postal service are lumped together as though they were a single class performing identical work under identical conditions. But even these unsatisfactory figures give the following result: the total annual loss from phthisis during the year 1896 was 2-4 per 1000 living, in 1897 it was 1-9 ; in 1898 it was 1-9 ; and in 1899 it was 1-7. The figures refer to the established staff, every member of which is a carefully selected life and has passed a series of severe medical examinations before entry into the service. According to the Registrar-General’s returns for the same years the loss among the general population from phthisis was 1’3 per 1000 living. It is unnecessary to remind readers of THE LANCET of the serious nature of this comparison. The loss among specially selected lives is considerably higher than among the general population, which includes the weak, the sick, and the rejected of the Post Office. In view of the gravity of these facts I have received permission to introduce the subject in the Section of State Medicine of the British Congress of Tuberculosis, and I trust that this will tend to bring into operation some such steps as have been adopted by the French Post-office. The English postal
Sms,-Apropos
of
June 22nd, p. 1794,
servants are not quite so helpless as your correspondent represents the French employes to be, and this may be the reason why the charity of the Postmaster-General has not yet
reached them. There is a curious coincidence in the fact that in the same issue of THE LANCET in which you record the generous action of the French Minister towards his minor employes you also publish a reply by Mr. Austen Chamberlain to Sir Walter Foster, M.P., in which he declines a return which would show the real loss from phthisis among the English postal staff. I have been using the best endeavours of a layman to draw attention to this matter for some six years ; may I now hope that
you
resides horses and stock. The slowness of the operations
NAVAL
AND
MILITARY CONCERT.
recently reported from South Africa has given rise to A grand naval and military concert under the patronage the impression that the reinforcements, especially of a of the King and the Queen will be held at the .mounted kind, are inadequate. Be this as it may, it is Crystal Palace in aid of service charities on Saturday impossible to doubt that the vast extent of country that has afternoon, July 6th, at 3 P.M., for the benefit of to be guarded and over which the operations extend, the the following funds :-The Soldiers’ and Sailors’ Families plitting up and dispersal of the Boers into numerous small Association, the Royal Naval Fund, the Soldiers’ Daugters’ bodies, and the enormous number of prisoners, women and Home, the Royal School for Daughters of Officers of children committed to our charge and requiring to be the Army, the Royal School for Naval and Marine treated in accordance with modern ideas of humanity and Officers’ Daughters, the Soldiers’ and Sailors’ Help philanthropy, make up a formidable as well as a very costly Society, Lady Lansdowne’s Officers’ Families Fund, ,undertaking-amounting to a weekly expenditure of some the National Memorial Gordon Boys’ Home, Lady While many people at home million and a quarter. Dudley’s Fund for Invalid Officers and Nurses, and the are declaiming against the evils of camps of concentraCentral British Red Cross Committee. Tickets for reserved tion and our inhumanity, independent military critics and numbered seats are one guinea and half-a-guinea rewho have been present at the seat of war are, on the other include admission to the Palace. They may spectively and band, astonished at the humane consideration, amounting as be obtained from the honorary secretary and treasurer, Mrs. they think to weakness, with which this war has been waged. Ronalds, 7, or from any of the usual libraries Madame Alice Bron, in her " Diary of a Nurse in South and ticket Cadogan-place, Extra fast trains will be run on the day agencies. has a very different story to tell and gives a very Africa," in and a display of fireworks will be given in different picture of the Boers to that presented by their thequestion As aspecial musical event the concert, with the massed evening. and in friends encomiasts this country and abroad. There is bands of 20 regiments numbering over 600 picked musicians, no denying the fact that the army medical officers who have will be a novelty. Full particulars of the programme will be served in South Africa are, as we have said, dissatisfied and announced in a few days. Miss Margaret Macintyre, Miss disappointed with the adverse criticism to which they have Marie Brema, Mr. Ben Davies, Mr. Santley, and Signor been exposed on the part of a number of irresponsible people Ancona have their assistance. kindly promised who were simply incompetent to form anything like a - correct estimate of the
situation
or
of
the
DEATHS
excellent
IN THE
SERVICES.
Lieutenant-Colonel George Lemon Walker, I.M.S., Pro,professional and administrative work which was done during this campaign-and generally under the most difficult and fessor of Medical Jurisprudence in the Medical College, trying circumstances. Nor, it must be admitted, are Madras, recently, aged 52 years. He entered the Indian speeches like that delivered by Dr. R. Craig Dun on the Medical Service in 1876, was promoted to surgeon-major in occasion of a dinner recently given by the pro- 1888, and to surgeon-lieutenant-colonel in 1896. He took part fession in Liverpool to the civil surgeons lately re- in the operations against the Rumpa rebels in 1879.
Correspondence.
-
__
_
-
-
__._
____
..........._............".......
1860 that I venture to raise the question of its wisdom. That raw milk may be contaminated by various bacilli-such as the bacillus tuberculosis, the bacillus typhosus, the bacillus diphtherias, the streptococcus soarlatinse, and even, through the addition of polluted- water, the bacillus enteritidis sporogenes and the bacillus coli communis-I fully admit. But are these evils so frequent and so fatal as to counterbalance the disadvantages arising from the diminution or destruction of the nutritive properties of milk which boiling undoubtedly prodnces7 And the gravity of the case is increased when it is remembered that milk should be the staple food of the infant, the child, the aged, and the sick. The occurrence of illness, epidemics, and death from the " presence of extraneous poisons in11 afresh or raw milk is certain, but could not these be met by greater care, enforced by more severe penalties for neglect, and by stopping the supply of milk when disease occurs without habitually destroying the nutritive value of milk by artificial means ? When railway accidents happen which maim and kill the. advice tendered is not that travellers should stay at home, but that more stringent precautions should be taken to prevent such disasters. And in the case of milk epidemics the remedy should not be habitually to diminish or to destroy the nutritive value of the most valuable food we possess, looking to the number whom it concerns, but to require sufficient precautions regulated by efficient inspection at the source of supply. I maintain that even the accidental poisoning of milk is much less baneful to the community generally than the destruction of its nutritive qualities, which means for artificially-reared infants rickets, infantile scurvy, and tuberculous diseases and for the aged and the sick deficient nutrition. These sufferings are incalculable and often lifelong, while those of epidemics are usually limited, owing to the care expended on their investigation by the medical officers of health. That "fresh"or raw milk cannot be so deleterious an article of food as ’is asserted is proved beyond all question by the fact that during a period of 30 years in which I have had charge of the health of a very susceptible community-a great public school-I have had only four cases of typhoid fever, three cases of diphtheria (not one of which was occasioned by milk), and none of tuberculous disease, and yet the boys drink an enormous quantity of milk-so great that I have been censured by a member of the profession for the quantity I advocate and have secured for their welfare, which is never boiled and rarely warmed. In my daily practice outside the school I am perpetually asked by those who have children to rear whether the milk ought to be boiled and my invariable answer is in the negative. For, if there is one thing that is essential to the vigorous growth of children it is a I plentiful allowance of milk. How children can be expected to develop on boiled milk and the constant restriction of , sugar is beyond comprehension. It is clear to me that the educated, as well as the uneducated, public require to be taught1. That the nutritive value of milk is very largely diminished by boiling. 2. That this is true also of sterilised milk, which should therefore only be used for a short time in order to tide over a difficulty in the early artificial feeding of infants. The nature of the change produced by the heating -of milk, and which is so deleterious, is not accurately ascertained, but I will produce an instance of its effect. Some time since I attended an infant who did not thrive and who was perpetually crying on the slightest movement. For this I was unable to account although I was answerable for its feeding. Because of its condition another opinion was sought and the child was declared to be syphilitic, so that mercury with chalk was prescribed, although, beyond doubt, no such taint existed in either parent. By-and-by, however, unmistakeable signs of infantile scurvy appeared, with the extreme pallor, the pain on movement of its lower limbs, the typical epiphyseal swellings of the lower ends of the tibias, and all the other symptoms so accurately described by Sir Thomas Barlow. It turned out that while I was responsible for the food a lady gossip was answerable for the milk-boiling, hence the result. As soon as this was rectified and anti-scorbutic food was administered the child begau to thrive and rewarded the mother for the care bestowed. 3. That while milk contains all the essential ingredients for growth, as well as nourishment-viz., albumin, fat, -
This sugar, salts, and water-it contains no starch. addition to the infant’s food which is so prevalent is most injurious to the welfare of the child. Until I can be convinced that the value of milk-boiling outweighs its defects I have but the advice to give to those who do me the honour to consult me-Don’t ! If ever the time should arrive that milk must be invariably boiled it should be done as soon as it leaves the cow’s udder and befoie it is distributed. But, at present, the issues of boiled milk, as I have pointed out, are milk are remote. The remedy for certain, those of unboiled the disadvantages of "fresh" or raw milk is not wasteful destruction of its nutritive value by boiling, but the enforcement of efficient inspection of dairy cows, dairies, milkers, and dairy keepers who supply it wholesale and the ensuring of cleanliness also on the part of the retailer. I am, Sirs, yours faithfully, CLEMENT DUKES, M.D., F.R.C.P. Lond. Rugby, June 14th, 1901.
"THE CONTAMINATION OF POST-OFFICES." To th8 Editors of THE LANCET. your article in THE LANCET of on the " Contamination of Postoffices," I should be obliged if you could allow me a little space in which to point a moral from the action of the French Government. And en passant may I remind you that I sent you a marked copy of the Telegraph Ohroniole some time back, in which I published a complete translation of Dr. Mignot’s report and the decrees thereanent which In 1895 I tendered eviM. Millerand had promulgated. dence to Lord Tweedmouth’s Committee which was designed to prove an unduly high incidence of phthisis among certain classes of employes in the English Post-office. This evidence received considerable attention from THE LANCET and other medical journals. In reply to my contentions it was stated that my figures were unreliable and referred to damaged lives. This contention I combated, and after some years of further study of the matter I am still of opinion that the statistics I gathered gave a substantially accurate view of the mortality rate from phthisis in the British postal service. They showed that of every 100 deaths among sorting clerks and telegraphists during a period of 10 years 45’4 per cent. were due to phthisis. Following upon the notice attracted to the question in 1895 the Postmaster-General commenced the publication of some meagre statistics in his annual report, and has continued to give these statistics up to the present time. They are unclassified, and the whole of the varied occupations of the postal service are lumped together as though they were a single class performing identical work under identical conditions. But even these unsatisfactory figures give the following result: the total annual loss from phthisis during the year 1896 was 2-4 per 1000 living, in 1897 it was 1-9 ; in 1898 it was 1-9 ; and in 1899 it was 1-7. The figures refer to the established staff, every member of which is a carefully selected life and has passed a series of severe medical examinations before entry into the service. According to the Registrar-General’s returns for the same years the loss among the general population from phthisis was 1’3 per 1000 living. It is unnecessary to remind readers of THE LANCET of the serious nature of this comparison. The loss among specially selected lives is considerably higher than among the general population, which includes the weak, the sick, and the rejected of the Post Office. In view of the gravity of these facts I have received permission to introduce the subject in the Section of State Medicine of the British Congress of Tuberculosis, and I trust that this will tend to bring into operation some such steps as have been adopted by the French Post-office. The English postal
Sms,-Apropos
of
June 22nd, p. 1794,
servants are not quite so helpless as your correspondent represents the French employes to be, and this may be the reason why the charity of the Postmaster-General has not yet
reached them. There is a curious coincidence in the fact that in the same issue of THE LANCET in which you record the generous action of the French Minister towards his minor employes you also publish a reply by Mr. Austen Chamberlain to Sir Walter Foster, M.P., in which he declines a return which would show the real loss from phthisis among the English postal staff. I have been using the best endeavours of a layman to draw attention to this matter for some six years ; may I now hope that
you